Epilogue

Neurobiological advances have clarified that it's nature, not nurture, that causes Asperger's syndrome (AS) or autistic spectrum disorders. The case reports of these authors and my own clinical work show how effective a psychoanalytically informed perspective can be when treating these patients. This perspective works because it recreates the early process of affective attunement between infant and mother, an experience of reciprocity that instills in the child the motivation for attachment and relatedness.

These clinical summaries demonstrate a variety of ways that this attunement process can be recreated in treatment to accommodate the atypical brain of the AS patient—a brain that, because it has great difficulty interpreting the intention of another, cannot experience being seen or found. Lacking this developmental step—of knowing oneself as another knows you—the AS patients described in the preceding pages did not know their own minds, which left them feeling isolated, alien, and unfound.

Recently, in December 2009, I was struck by a New York Times article that reported the following: “Runaway 13-year-old spent 11 days in the subways despite frantic hunt.” This headline described the escape chosen by a boy diagnosed with AS after he was reprimanded in school for not completing an assignment. Finally found after an exhaustive 11-day search (involving police, parents, family friends, and identifying flyers), the boy was asked to comment on his experience and said, “Nobody really cares about the world and about people”—a statement painfully at odds with his mother's response. “I tell him ‘Talk to me. Tell me what you need. If I ever make a mistake, tell me …’ I don't know as a mother how to get to his heart … to find out what hurts.”

This adolescent boy, in the language of our authors, “put his mind into action” and hid among the commuter crowds of the Manhattan subways, where he remained lost for a remarkable expanse of time, successfully proving his point! I